Barrett’s Esophagus-Managing The Risks

Patients with acid reflux should know that there is a risk over the long term of developing Barrett’s Esophagus (BE), when the lower esophageal squamous mucosa transforms into intestinal metaplasia. And you know that there is the potential for the Barrett’s mucosa to progress to esophageal adenocarcinoma (EAC). It is a growing dilemma as the number of patients with esophageal adenocarcinoma has increased by 500% over the last 40 years. Here are some of the key points to consider when evaluating your GERD and Barrett’s, please always consult your Gastroenterologist:

• Barrett’s esophagus is common – occurring in approximately 5% of GERD populations surveyed endoscopically.
• The most recent large population studies suggest that the risk of Barrett’s esophagus progressing to esophageal carcinoma is actually much lower than previously estimated – a risk of 0.1-0.2 % per year rather than .5% per year as previously estimated.
• Screening all patients with GERD for Barrett’s esophagus has not proven to be cost-effective. Certain subsets of patients who have identified risk factors for the development of Barrett’s esophagus and for esophageal cancer should be considered for screening. These include:
• Older white males, especially those with obesity and a smoking history.
• Patients with long-term GERD over age 50 who have never had an EGD.
• Patients with a family history of Barrett’s esophagus.

• In patients diagnosed with Barrett’s esophagus, the following are key guideline recommendations:
• All patients should be on long-term PPI which have been proven to significantly reduce the risk of progression to esophageal cancer.
• Patients with Barrett’s esophagus should undergo surveillance endoscopy with biopsies every 3 to 5 years. The goal is to identify the dysplastic changes within the Barrett’s epithelium which usually occur well before carcinoma develops.
• If low-grade dysplasia is noted on 2 successive endoscopic exams or if high-grade dysplasia is ever noted, radiofrequency ablation (RFA) should be considered.

This minimally invasive catheter-based technique has proven to be a safe and effective way to eradicate Barrett’s dysplastic mucosa. It is expensive, however, usually requires 3-4 sessions to ablate all dysplastic tissue and ongoing endoscopic surveillance is still required.

References:
Amer Soc Gastrointest Endo Barrett’s Guidelines. ASGE Journal 2012, Vol 76:6:1087
Radiofrequency Ablation. Gastro 2013, 144 (5), S187